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The RSI case of Sanjeev Sabhlok: description of the problem and its treatment.

Section 1. Physical symptoms

(Symptom 1) Towards the end of 1998, while completing a PhD in USA and that the same time working intensively on a policy/ political project, for a total period of nearly 16 hours a day for weeks on end, I started experiencing pain in my right forearm that would not go away.  Went to the doctor.

(Symptom 2) Symptom 1 continued while additional symptoms got added on a fairly rapid succession I started experiencing strong burning sensations on the skin of the forearm and hands, and pain in the hand area. This came on pretty rapidly after the first symptoms. The key feature was that the pain would not go away with any amount of treatment with anti-inflammatories, Tiger balm, or any other pain relief gel found over-the-counter.  Wearing a full sleeved shirt or jumper/sweater became difficult because the skin would burn where the cloth touched it.

One of the biggest problems through this period and since then till recently was that I could not write with my hands or type. Signing my credit card receipts at shops became extremely severe problem, as my signature stopped matching, due to the pain of holding of using a pen.

Washing dishes, which involves a little bit of scrubbing and a rotatory motion, was another extremely painful activity. Using a screw driver was equally painful. In the acute stage - for practically three years, it was not only very painful to carry a bag of groceries, but even to stir a cup of tea. There was also enormous fatigue in the hands, making it very difficult to do shopping. Fatigue was quick to occur in the hands.

(Symptom 3) Symptoms 1 and 2 continued while in early January, 1999 my entire left-arm went completely numb one night, a most distressing experience, that made me scurry to the doctor again.

(Symptom 4) The full arm numbness returned only after another three years or so, but numbness of fingers related to median nerve compression, bilateral, was experienced by me over the next few weeks.  Symptoms 1,2 continued.

(Symptom 5) Around March 1999. Symptoms 1, 2, 4 continued and symptom 2 intensified and expanded.  Pain in various parts of the upper limb was a constant problem.  I had registered for a French class during the last term of my PhD to take advantage of my Fellowship the permitted such classes to be taken. Within a few weeks I had to drop out since it acquired taking notes by hand and I could not put my forearm on the desk while taking notes.

(Symptom 6) June 1999. Symptoms 1, 2, 4 continued. The burning sensations had converted themselves into terrible gripping sensations, of all sorts, across the entire upper limbs. It must be noted that most of the symptoms varied over the course of a day, with most symptoms increasing after a heavy day of typing.

(Symptom 7) September 1999-March 2001. This was a period of reduced typing. While some acute pain in the forearm and upper arm subsided, the hands and fingers continued to be painful, particularly the fingers which experienced various kinds of sharp pain. Numbness in the fingers covered by the median nerve continued at night. In August 2000, the numbness of the fingers expanded to the fingers covered by the ulnar nerve, bilaterally.

Sometime around this period, the tip of my left elbow had developed a small "hole" - making it extremely painful and sensitive if it ever touched a hard surface.

(Symptom 8) March to August 2001.  In a job in Australia that required intensive typing, almost all the acute symptoms - symptom 5, came back, and and many more were experienced. In particular, the shoulder area and upper arm became extremely painful, and extreme pain was experienced at the back of the upper arm, the ..... muscle. By this time, a painful area, the size of a golf ball had formed in the upper forearm, that would not go away with any amount of treatment. When the symptoms arrived at the shoulders, lifting the arms up to hang clothes to dry fatigued my shoulders in a matter of seconds.  

(Symptom 9) December 2001. Intense pain spread to the upper back, with sharp burning sensations when the neck was turned.

(Symptom 10) mid-2002. The intense upper back pain brought under some control but both arms began to get numb, either from the forearm downwards, or from the shoulder downwards, while sleeping on that particular side.

(Symptom 11) mid-2002.  Increasing mental distress including very significant contemplation of suicide. Two months later there was some relief of upper back symptoms consequent to six months of shiatsu massage, and a more hopeful attitude emerged.

(Symptom 12) mid-2003.  Numbness of arms at night in any posture, including while flat on the back, and soreness, slightly better than usual due to ongoing therapy.

(Symptom 13) late 2003. Pectoral muscles get involved in acute pain. Pain then spread downwards, and side-wards, down the sides of the abdomen.

(Symptom 14) mid-2004.  All the above and pain now spread to stomach muscles.

(Symptom 15) September 2004.  A tight ring of acute pain formed around the lower abdomen and the lower back.  In the last stage of expansion of the areas of pain to a "girdle" around the waist, it became extremely painful even to sit. Simultaneously there was significant reduction in the pain around the chest and stomach. The significant increase in pain 3 weeks ago was in the waist area, but it is now, in hind-sight, caused by the transfer of mechanical force to these major muscles, as the tension in the shoulder was easing.

Three weeks later, in late September, the pattern of pain and its resolution is now clear.